November 15, 2023

Digital claims deliver healthy transformation

NAB’s digital claims solution has enabled a system of fast, transparent payments for healthcare practitioners, government schemes and the communities they support.

A comprehensive digital payments ecosystem is a key pillar to help unlock the growth pathways and innovation needed to optimise patient care for the nation’s future health.

This is the view of Simon Terry, CEO of NAB’s Health Industry Claims and Payments Service (HICAPS), and other participants in the sector, who are working to relieve the administrative burdens and financial inefficiencies of an analogue past.

“It’s about processing claims fast, accurately and securely in the digital age,” Terry says. “With government claims, for instance, this can mean the difference between health and care providers being paid in six weeks or being paid overnight.”

HICAPS is widely used by practitioners including doctors, dentists and allied health professionals to process electronic claims and payments at the point of service, through terminals and the digital platform.

The system is linked to all Australian health insurance funds, as well as a growing list of government statutory payment schemes including Medicare, WorkSafe Victoria, the Transport Accident Commission of Victoria (TAC) and the National Disability Insurance Scheme (NDIS).

Terry says the strong proposition HICAPS has for service providers and government agencies is the delivery of real-time confirmation of patient eligibility and payment information, with the funds transferring overnight.

Integration with the practice management systems used to run clinics means managers can trigger the claims flow without having to re-key the information, while the richer payments data contained in the remittance helps to automate the reconciliation process.

As well as delivering these payment efficiencies, HICAPS can also help onboard and verify providers for insurance and government schemes, Terry says.

“The overall vision for HICAPS is to enable all the Australian health and care community to work digitally together on one platform to deliver the best experiences for Australian consumers and Australian payers,” he says.

“This better customer experience helps in enhancing loyalty and revenue for the funds and providers and delivers better outcomes for participants involved with government schemes.”

Supporting government agencies

A case in point is Victoria’s TAC, which provides financial support for those injured on the state’s roads, or in a Victorian-registered vehicle, with the service funded through that registration.

TAC Senior Manager, Claims Systems and Improvement, Cameron Baum, says before adopting the HICAPS digital solution, the TAC was looking for a way that would simplify and speed up the payment process and streamline how health providers engage with the TAC.

The TAC wanted to make it easier for providers to check on patient eligibility and to give them a digital option to email or paper-based invoicing that would increase their certainty around payments and reconciliation, Baum says.

“We clearly wanted to be easier to deal with for those providing a service to TAC clients,” he says. “With HICAPS digital claims we’ve reduced that friction, so providers are paid overnight and have real-time certainty about that payment with instant acknowledgement around patient eligibility.”

The TAC today processes about 1.1m digital claims each year using the HICAPS system, which forms a significant share of their total claims overall.

Healthy business growth

On the provider side, Sue Barnwell is Integrations and Operations Coordinator with healthcare group Healthia, which runs a network of more than 320 allied health practices across Australia and New Zealand.

Barnwell says HICAPS has helped to deliver an 80 per cent improvement on administrative efficiencies, mainly through time saved across the provider businesses using it.

Faster processing of invoices means enhanced revenue capture which translates into “cash in the bank” and is a “real positive” for the finance department, she says. “One of our central success pillars at Healthia is driving tech-enabled healthcare, so this certainly aligns with our values for our clients and the business.”

Another plus is the ability to have payments from a government scheme or fund automatically directed to the account it was claimed from rather than having to manually reconcile to individual clinics around the network from the central ABN bank account.

“The administrative burden of reconciliation and trying to find where that money has landed is reduced immensely,” Barnwell says. “It’s much simpler, straightforward and accurate working off one practice management system and one finance system.”

Taking a load off

A front-line example of how the digital claims system is working for Healthia is at their Back in Motion Health Group clinics. The brand delivers a range of allied health services including physiotherapy and clinical exercise for clients including TAC participants in Victoria.

“It really takes a load off,” Back in Motion Practice Manager Lisa Pemberton says. “It means you can spend more time with your clients, and communicating with team members, and not have to be constantly chasing up your paperwork and debtors.”

Pemberton says before using HICAPS, the business would only find out about any eligibility issues through manual reconciliation, potentially months later.

She says the real-time digital claims verification has helped avoid difficult conversations with customers around delayed payments and allowed Back in Motion to continue to meet expectations of care.

Future health

HICAPS today delivers tailored solutions to more than 96,000 registered health practitioners across the country and processes more than 41 million claims annually.

For CEO Simon Terry, the continued digital rollout and integration across more than 40 modalities is pivotal in enabling businesses to grow and encompass more specialist services.

As Australia faces into the demographic challenge of an ageing population, Terry says these system efficiencies help the shift to more targeted and preventative in-home care and take pressure off hospitals.

“At HICAPS we can receive all those different care services digitally, coordinate them digitally and actually manage the payment digitally. We’re constantly pushing the envelope to deliver the solutions Australia needs into the future, because that’s the digital world we live and work in today.”

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